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Application of Nasobiliary Duct Instead of T-tube in Laparoscopic Common Bile Duct Exploration and Primary Suture

Chinese Journal of Minimally Invasive Surgery.2014;(4):314-316. doi:10.3969/j.issn.1009-6604.2014.04.008

Objective To explore the application value of nasobiliary duct instead of T-tube in primary suture after laparoscopic common bile duct exploration (LCBDE). Methods A total of 58 cases of choledocholithiasis without acutecholangitis were divided into experimental and control group according to the odevity of the last number of admission number .Patients in odd number belonged to experimental group , while the even number patients belonged to control group .The experimental group received endoscopic nasobiliary drainage ( ENBD ) combined with LCBDE and primary suture;the control group underwent LCBDE combined with T-tube drainage .The intraoperative and postoperative data were compared between the two groups . Results All surgeries were completed successfully under laparoscope .The experimental group had much shorter hospital stay than that of the control group [(7.5 ±2.1) d vs.(10.3 ±3.2) d,t=-3.965,P=0.000].No significant differences were found in the operative time , incidence of bile leakage and postoperative incision pain between the two groups (P>0.05).All the cases were followed up for 6-12 months (average, 9 months) and no patients were hospitalized due to complications related to the billiary surgery .MRCP showed no complications such as biliary stricture and residual stones 6 months after operation . Conclusions Nasobiliary duct can substitute for T-tube in LCBDE .It ensures the safety of the primary suture and reduces T-tube related complications .

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Endoscopic-assisted Foley Catheterization for Bulbous Urethral Injury

Xinming ZHANG ; Zongyue YE ; Deying GUO

Chinese Journal of Minimally Invasive Surgery.2014;(4):367-369. doi:10.3969/j.issn.1009-6604.2014.04.025

Objective To evaluate the clinical methods and results of endoscopic-assisted catheterization in the treatment of bulbous urethral injury . Methods The clinical data of 19 cases of bulbous urethral injury from July 2004 to September 2012 managed by ureteroscopic catheterization were retrospectively analyzed . Results The procedures were successfully completed in all the 19 cases.Foley catheters were removed in 4-8 weeks after the surgery and all cases had unobstructed ureter after the removal of the catheter.Urethral dilatation was done regularly for 4 times and all the cases were followed up for 6-12 months afterwards.The follow-up showed urinary flow rate was more than 15 ml/s, and no urethral stricture , urinary incontinence or other complications occurred.Erection of penis was not obviously affected compared with preoperative condition . Conclusion Endoscopic-assisted catheterization is effective in the treatment of bulbous urethral injury .

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Clinical Value of Shortening Double-J Stent Indwelling Time in the Treatment of Ureteral Stone-street Complications after Flexible Ureteroscope Lithotripsy

Rui HUANG ; Xiaowen LIANG

Chinese Journal of Minimally Invasive Surgery.2014;(4):350-352. doi:10.3969/j.issn.1009-6604.2014.04.020

Objective To investigate the clinical value of shortening double-J stent indwelling time in the treatment of ureteral stone-street complications after flexible ureteroscope lithotripsy . Methods Clinical data of 38 cases of ureteral stone-street complications following flexible ureteroscope lithotripsy from January 2012 to December 2013 in our hospital were retrospectively analyzed.The patients were divided into Group A (extubating the double-J stent two weeks after the surgery ) and Group B (retaining the double-J stent) with 19 cases in each group .The stone clearance results were compared . Results All the urinary calculus in Group A had been removed successfully , including 2 cases of renal colic , 3 cases of irritative symptoms of bladder and 3 cases of gross hematuria.Hospital cost was (766.5 ±153.7) yuan.Urinary calculus were successfully removed in 13 cases in Group B, including 19 cases of gross hematuria and 17 cases of irritative symptoms of bladder.No renal colic occurred.The hospital cost was (1251.2 ± 155.6) yuan.Compared with Group B , Group A has higher success rate of stone clearance , lower hospital cost and lower rate of bladder irritative symptoms and gross hematuria (P<0.05).There were no significant differences between the two groups in the occurrence rate of renal colic (P>0.05). Conclusions Removing the double-J stent 2 weeks after flexible ureteroscope lithotripsy resulted in higher stone clearance rate and less complications compared with retaining the double -J stent.It can reduce the occurrence of irritative symptoms bladder and gross hematuria .

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Comparison Between Cervical and Extra-cervical Surgical Approaches for Endoscopic Thyroidectomy：a Randomized Controlled Study

Chengliang WU ; Gengzhen CHEN ; Hui HAN

Chinese Journal of Minimally Invasive Surgery.2014;(4):320-323. doi:10.3969/j.issn.1009-6604.2014.04.010

Objective To compare the therapeutic effects between cervical and extra-cervical surgical approaches for endoscopic thyroidectomy . Methods From October 2012 to December 2013, forty-four thyroid goiter patients were divided into two groups randomly .Group A underwent modified Miccoli endoscopic thyroidectomy ( n =20 ) and group B underwent endoscopic thyroidectomy via breast areola approach ( n=24 ) .The operative time , intraoperative blood loss , pain in 24 hours postoperatively , drainage volume , postoperative hospital stay , hospital cost , complication and cosmetic results between the two groups were compared . Results Compared with group B, group A had shorter operative time [(77.9 ±28.3) min vs.(97.9 ±30.0) min, t=-2.259, P=0.029], less intraoperative blood loss [(15.9 ±8.7) ml vs.(29.5 ±16.1) ml, t=-3.384, P=0.002], less pain in 24 hours postoperatively ( no pain, endurable pain , intolerable pain in group A and B were 15, 5, 0 and 7, 15, 2 cases respectively , Z=-3.066, P=0.002), less postoperative drainage volume [(31.7 ±10.3) ml vs.(57.0 ±14.6) ml, t=-6.511, P=0.000], but poorer cosmetic results (very dissatisfied, not satisfied, satisfied, comparatively satisfied, and very satisfied in group A and B were 1, 4, 5, 6, 4 and 0, 1, 4, 5, 14 cases respectively, Z=-2.723, P=0.006).There was no significant difference in postoperative hospital stay and hospital cost between the two groups (P>0.05).One case suffered transient hoarseness in group A and one case had trembling hand due to low calcium level in group B and both of them recovered 1 month after symptomatic treatment .No permanent recurrent laryngeal nerve injury , parathyroid injury or other complications occurred in both groups . Conclusions Cervical approach is minimally invasive and leads to good cosmetic results while extra-cervical approach causes bigger trauma but leads to better cosmetic results.Patients with high cosmetic reguest may choose endoscopic thyroidectomy via breast areola approach .

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Laparoscopic Diagnosis and Treatment of Small Bowel Tumors in 24 Patients

Wei LIU ; Peng YANG ; Yuxiao ZHAO

Chinese Journal of Minimally Invasive Surgery.2017;17(10):933-935. doi:10.3969/j.issn.1009-6604.2017.10.020

Objective To evaluate the clinical value of laparoscopy in the diagnosis and surgical treatment of small intestinal tumors. Methods After the establishment of pneumoperitoneum with umbilicus puncture, a laparoscope was inserted.Two 5-mm trocars were placed through lateral right and left rectus abdominis to explore the location of the small intestine tumors.A 3 -4 cm incision was made along the abdominal midline or lower abdomen median.With the use of incision protector,benign tumors were given local excision of small intestine,or malignant tumors were given radical resection.End to end or side to side anastomosis of bowel was carried out,and then the mesenteric hole was closed and the puncture hole sutured. Results All the patients were diagnosed and treated by laparoscopic procedure successfully, including 23 cases of laparoscopic-assisted partial intestinal resections and 1 case of right hemicolectomy.The mean operative time was(70.3 ±21.7)min,the mean blood loss was(18.5 ±3.1)ml,the mean length of incision was(3.5 ±1.1)cm, and the mean time for passage of flatus was(2.5 ±0.5)d.Postoperative pathological examinations showed benign tumors in 8 cases,most of which were leiomyoma(5 cases), and malignant tumors in 16 cases, most of which were stromal tumors(6 cases).The postoperative hospital stay was(6.5 ±2.5)d.Follow-ups were conducted for 0.5-4.5 years(mean, 2.6 years)in 19 cases,including 6 cases of benign tumor and 13 cases of malignant tumor.No recurrent tumor was found except one fatal case of advanced intestinal carcinoma. Conclusion Laparoscopic exploration can diagnose small intestinal tumors accurately, and laparoscopic-assisted surgical treatment is safe.

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Microvascular Decompression Treatment of Vertebrobasilar Related Trigeminal Neuralgia

Hui XIANG ; Jingxing LENG ; Ruen LIU

Chinese Journal of Minimally Invasive Surgery.2017;17(10):930-932. doi:10.3969/j.issn.1009-6604.2017.10.019

Objective To summarize the microvascular decompression(MVD)surgery of vertebrobasilar blood vessel for primary trigeminal neuralgia patients. Methods Clinical data of 28 primary trigeminal neuralgia patients caused by vertebrobasilar blood vessel from October 2008 to June 2016 in our hospital were retrospectively analyzed.There were 25 patients receving MVD and 3 patients receiving MVD and trigeminal sensory-root partial rhizotomy. Results The neuralgia in all the 28 patients immediately disappeared after surgery.Facial hypesthesia on the operation side occurred in 3 patients receiving MVD and trigeminal sensory-root partial rhizotomy.During follow-ups for 3 -24 months(mean, 18.6 months), none of the trigeminal neuralgia relapsed. Conclusions For primary trigeminal neuralgia patients caused by vertebrobasilar blood vessel, adequate nerve decompression and restoration of normal nerve anatomy are the guarantee for the efficacy of MVD surgery.For vessels with tensions and can not be passaged by one-time,multi-point decompression can complete the surgery.

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Comparison of Dexmedetomidine and Tramadol to Prevent Postoperative Shivering After Liposuction

Weixuan SHENG ; Binjiang ZHAO ; Lei GUAN

Chinese Journal of Minimally Invasive Surgery.2017;17(10):926-929. doi:10.3969/j.issn.1009-6604.2017.10.018

Objective To observe the efficiency and safety of dexmedetomidine and tramadol to prevent postoperative shivering after liposuction. Methods A total of 80 patients undergoing liposuction were randomly divided into 4 groups with 20 cases in each group:dexmedetomidine 0.4 μg/kg(D1 group),dexmedetomidine 0.6 μg/kg(D2 group),tramadol 1 mg/kg(T group),and saline control group(N group).These patients received an intravenous injection of dexmedetomidine, tramadol, or saline at the time of surgical suture.The respiratory recovery time,awakening time, extubation time, orientation recovery time, the case of shivering and adverse reactions after surgery were recorded. Results The respiratory recovery time,awakening time, and extubation time in the group D2 were longer than those in the other 3 groups[respiratory recovery time:(5.5 ±1.3)min vs.(6.2 ±1.2)min vs.(5.1 ± 1.8)min vs.(5.0 ±0.9)min,F=3.330,P=0.024;awakening time:(10.2 ±1.3)min vs.(11.5 ±1.5)min vs.(9.7 ±2.7) min vs.(9.5 ±1.8)min,F=4.429,P=0.006;extubation time:(12.9 ±1.5)min vs.(14.2 ±1.6)min vs.(12.8 ±2.4)min vs.(12.7 ±1.9)min,F=2.845,P=0.043].Postoperative shivering incidence in the group N was higher than those in the other 3 groups(3 cases vs.2 cases vs.3 cases vs.9 cases,χ2=9.188,P=0.027).The incidence of nausea and vomiting in the group T was higher than those in the other 3 groups(2 cases vs.1 case vs.8 cases vs.4 cases,χ2=9.436,P=0.024).The incidence of tachycardia in the group D2 was higher than those in the other 3 groups(3 cases vs.7 cases vs.1 case vs.1 case,χ2=9.412, P=0.024). Conclusion Dexmedetomidine 0.4 μg/kg by intravenous injection can treat postoperative shivering after liposuction effectively and reduce the adverse reactions.

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Effects of Two Different Hemostatic Methods of Electric Coagulation or Suture Hemostasisa on Ovarian Reservation Function After Laparoscopic Ovarian Surgery

Jingjing WANG ; Yahong LIU ; Xiaoyan YING

Chinese Journal of Minimally Invasive Surgery.2017;17(10):877-881. doi:10.3969/j.issn.1009-6604.2017.10.004

Objective To evaluate the effects of electric coagulation or suture hemostasis on ovarian reservation function in laparoscopic ovarian cyst removal for ovarian endometriomas. Methods A total of 118 patients receiving laparoscopic ovarian cystectomy in our hospital from January 2011 to June 2015 were enrolled in this study.According to the habit of different operators,the patient were devided into either electric coagulation group(n =53)or suture group(n =65).The follicle-stimulating hormone (FSH),luteinizing hormone(LH),estradiol(E2)and antral follicle count(AFC)of the two groups were observed and compared before surgery and one and six months after surgery. Results There were no differences in the levels of the FSH,LH,E2and AFC between the two groups before the surgery(P>0.05).The level of FSH was increased and those of E 2and AFC were declined in both groups at 1 month after the operation compared with those before operation(P <0.05).Moreover, there were more significant differences in FSH,E2,and AFC in the electric coagulation group(P <0.05).There was no significant difference in LH(P>0.05).The levels of FSH and E 2recovered in both groups at 6 months after operation.There was no difference in FSH and E 2 compared with the level before operation in the suture group(P>0.05), however, there was significant difference in the electric coagulation group(P<0.05). Conclusions The laparoscopic ovarian cystectomy for ovarian endometriomas leads to decreased ovarian reserve.As compared to bipolar coagulation, suture hemostasis can effectively reduce the damage of ovarian function, which should be applied as possible as we can.

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Experience of 26 Cases of Laparoscopic Surgery for Pedicle Torsion of Ovarian Cyst with Pregnancy

Yuanyuan SUN ; Lirong TANG

Chinese Journal of Minimally Invasive Surgery.2017;17(12):1091-1093. doi:10.3969/j.issn.1009-6604.2017.12.011

Objective To investigate the experience of laparoscopic surgery for pedicle torsion of ovarian cyst with pregnancy. Methods A retrospective analysis was made on 26 cases of pregnancy complicated with pedicle torsion of ovarian cyst receiving emergency laparoscopic surgery from January 2009 to December 2016 in our hospital. After the establishment of pneumoperitoneum, laparoscopic cyst dissection or accessory resection of the affected side was performed according to intraoperative conditions. Patients with early pregnancy were given progesterone 20-40 mg intramuscular injection, once a day for 3 days. Patients with late pregnancy were given intravenous drip of magnesium sulfate, 5 g daily for 3 days. The pregnancy outcome was recorded by readmission records, outpatient visits, or telephone follow-ups. Results Laparoscopic surgery was performed in all the 26 patients. During operation, 11 patients with ovarian necrosis underwent affected side resection, and the remaining 15 patients underwent enucleation of the affected ovary. The operation time was 20-60 min (average, 47. 8 min). The intraoperative bleeding was 10-400 ml (average, 88. 8 ml). The hospitalization time was 2-16 d (average, 5. 8 d). There were 21 cases of postoperative tocolytic therapy (80. 8%). All the 26 patients had no symptoms of miscarriage or premature delivery. They continued to term delivery, including 13 cases of spontaneous labor and 13 cases of caesarean section. The newborns were healthy, with 1-and 5-min Apgar scores of 8-10 points. Conclusions It is safe to treat the pregnancy complicated with pedicle torsion of ovarian cyst by laparoscopic surgery. Surgery is difficult for large cysts and late pregnancy.

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Application of Keyhole-style Total Removal of the Glands for Male Gynecomastia

Bangwu DAI ; Sidong ZHANG

Chinese Journal of Minimally Invasive Surgery.2014;(9):827-829. doi:10.3969/j.issn.1009-6604.2014.09.018

Objective To evaluate the effects and cosmetic results of total removal of the glands for male gynecomastia . Methods A total of 13 male patients with gynaecomastia were operated by using the method of keyhole-style total removal of the glands from March 2012 to March 2013.The fat lysate was injected into the subcutaneous area of the breast enlargement .Then an incision about 1.0 cm in length was made by the side of areola , through which a vacuum aspiration was carried out to suck the fat tissues.Also, the hypertrophical breast tissues were excised gradually .Finally, the incision was closed with medical biological adhesive or absorbable suture . Results The time of unilateral operation was 40-100 min ( average , 70 min) .The amount of blood loss was 20-50 ml (average, 30 ml).Subcutaneous effusion occurred in 2 cases (accompanying local hematoma in 1 case), which was cured by repeated aspiration for 3 days.The postoperative hospitalization was 2-5 days (mean, 2.8 days).All the patients were cured with incision healed by first intention and no obvious scars left .There was no necrosis on the nipple or areola .The breast curve was flat and natural .A total of 8 cases were followed up for 3 months, with satisfactory appearance .Three patients felt numbness of nipples and areola of breast after surgery and the symptom disappeared 3 months later . Conclusion Keyhole-style total removal of the glands for the male ynaecomastia has advantages of easy operation ,safety,and good cosmetic results .

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